ESPECIALIDAD EN COLOPROCTOLOGÍA

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    COMPARACIÓN DEL USO DE DISPOSITIVO MONOPOLAR FRENTE AL USO DEL DISPOSITIVO ULTRASÓNICO EN HEMORROIDECTOMÍA PARA DETERMINAR LA EVOLUCIÓN TRANS Y POSTQUIRURGICA EN EL HOSPITAL TEODORO MALDONADO CARBO EN LA UNIDAD DE COLOPROCTOLOGÍA PERIODO 2014 AL 2015
    (2017) Rodríguez, Martha; Sierra, Ernesto
    Background. -Hemorrhoid disease represents one of the most common of the anal canal pathologies and their treatment generates much interest, different techniques to treat hemorrhoids there are grade III-IV, such as hemorrhoid ligation, sclerotherapy and cryotherapy which present lower on the surgical treatment results which makes it necessary to consider different technical surgical and instruments for its implementation. Objectives. -This study was general objective to compare the use of monopolar device against the use of the ultrasonic device in hemorrhoidectomy in Trans and postoperative evolution "Teodoro Maldonado Carbo" hospital in the unit of Coloproctology period 2014 to 2015, which was considered the time transquirurgico, postsurgical bleeding, pain score and wound healing time. Methodology. -Is a study with a design descriptive, retrospective case-control, with sampling non-probability, for convenience in a population of patients who presented haemorrhoids grade III and grade IV and which were intervened surgically with technical Parks, modified submucosa. They were made of two groups, the control group with 134 patients (monopolar device) and 50 patients in the case (ultrasonic device). Results. -Among the most important results are observed a time surgical less in them patients operated with scalpel harmonic (31, 2±3 minutes) facing Electrosurgical unit (43, 2±2, 3 minutes), is noted also a difference between the scale of the pain between both surgeries, presenting best results in the Group case. Is appreciated a rate of bleeding and a time of healing xii minor, which was documented by other authors in the field international. The patients of both groups presented a high degree of satisfaction with the surgery. Conclusion. -The use of the ultrasonic Hemostatic device, is constituted as an effective instrument with lower hospital costs, due to surgical time decreases better healing, so it decreases the incapacity for work and should be considered as "standard" use in the hospital
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    EVALUACIÓN DE LA CONDUCTA TERAPÉUTICA DE LA DIVERTICULITIS AGUDA, EN LA UNIDAD DE COLOPROCTOLOGÍA DEL HOSPITAL TEODORO MALDONADO CARBO, EN EL PERÍODO 2010 AL 2014
    (2016) Loyola Segura, Dora María; Sierra Montenegro, Ernesto
    Diverticulitis, which may be acute or chronic, in the first case, corresponds to the appearance of the clinical picture for the first time and in chronic cases, when the patient presents acute attacks with relapse from time to time. The most frequent outcome of diverticulitis is the intraluminal abscess of the diverticulum, with an increase of 5.9% in 2000 to 9.6% in 2014. The other complications of diverticular disease that begin as diverticulitis, such as perforation , Hemorrhage, stenosis and fistulae, did not present significant changes in their insidence, in the same period. After data collection and reviewing the international literature, results were obtained not far from those recorded in other countries, such as; incidence in the sixth decade of life with 45,26%. The distribution of patients according to sex, with the highest rate of acute diveticulitis in males with 62,77%. Finally, with tha data analysis, satisfactory results were obtained boh in s n controlled by the outpatient clinic.
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    VARIACIÓN DE LA PRESIÓN DE PULSO DURANTE LA VENTILACIÓN MECÁNICA COMO PREDICTOR DE HIPOVOLEMIA EN EL PACIENTE SÉPTICO EN LA UNIDAD DE CUIDADOS INTENSIVOS DEL HOSPITAL IESS TEODORO MALDONADO CARBO DE GUAYAQUIL 2015-2016
    (2017) Ortega Matute, Fabián Augusto; Torres, Cesar
    Pulse rate variability (PPV) is a parameter that not only indicates the condition of the intravascular volume of the patient, but also predicts the response after fluid administration; The aim of our study was to compare the percentage values of the Pulmonary Pressure (PPV) variation with the traditional hemodynamic parameters: central venous pressure, mean arterial pressure and heart rate (PVC-TAM-FC); As predictors of hypovolemia in the septic patient in mechanical ventilation. The method used for the study was observational, which included patients diagnosed with septic shock in mechanical ventilation, monitored through an arterial catheter connected to the floc-trac system; The study excluded patients with mitral valvulopathy, arrhythmias and chronic obstructive pulmonary disease. The results obtained from July 2015 to December 2016 were collected from a total of 342 clinical records of patients admitted to the Intensive Care Unit; But only 70 patients met the inclusion criteria, 51% were male and 49% female, mean age 50 ± 5, SOFA scale with one or two organ dysfunctions; Whose time of clinical evolution was> 8 hours in 54%; Fluid refractory hypovolemia was 21% associated with a 71% mortality; Levels of variation of pulse pressure> 12% and central venous pressure (PVC) <8cmH20 were compared within the first hours of evolution; Blood pressure was compared between the range of 66 to 70 mmHg with PPV levels between 9-12%; The comparison between cardiac index and PPV was 17 cases between the ranges of <2.8 (l / min / m2) and <12% for PPV. The range of <8mmHg of PVC and> 12% of VPP was used as a resuscitation measure to reanimate patients in shock. We recommend prospective studies comparing the variation of pulse pressure with other more sensitive and specific measures to determine the patient's volemia status, such as measuring the degree of distension of the vena cava, pulmonary artery catheter, in order to know the role Diagnosis of hypovolemia in ventilated septic patients.
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    “ESTUDIO DEL TIEMPO DE TRANSITO COLONICO CON MARCADORES RADIOPACOS EN PACIENTES ATENDIDOS EN EL SERVICIO DE COLOPROCTOLOGÍA DEL HOSPITAL TEODORO MALDONADO CARBO
    (2017-01) Yanqui Salazar, Ricardo Miguel; Cruz Lavayen, Víctor Emilio
    Se ha definido el TTC como el tiempo en el que transcurre el contenido intestinal desde el ciego hasta el ano. Muchos pacientes acuden al médico con el síntoma principal de constipación los cuales algunos lo hacen en relación exclusiva a las evacuaciones, otros pacientes lo relacionan con pujo, dolor y evacuaciones duras. Existen en la actualidad dos métodos para realizar este estudio que son marcadores radiopacos y con radioisótopos. La evaluación del TTC más fácil y simple de interpretar fue propuesta inicialmente por Hinton y Leonard Jones con un tubo radiopaco se corta en 20 anillos cada uno de ellos de 2mm de grosor aproximadamente aunque originalmente se requirió radiografía de abdomen simple cada día hasta eliminar totalmente los marcadores además refieren que una placa de abdomen al tercer y quinto dio es suficiente.
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    FACTORES PRONÓSTICOS ASOCIADOS A COMPLICACIONES POSTQUIRÚRGICA TEMPRANAS EN CIRUGÍA DE COLON Y RECTO EN EL HOSPITAL TEODORO MALDONADO CARBO 2013 A 2016
    (2016-01) Xavier Augusto, Obando Pasmino; Cruz Lavayen, Víctor
    Introducción: Aproximadamente 600.000 pacientes se someten a cirugía colorrectal en EEUU anualmente, mismas que tienen un alto riesgo de complicaciones, estas varían en diferentes series, pero se estima que oscila entre 10 y 30 % y se reporta una incidencia de readmisión del 7% al 27% durante los primeros 30 días y una mortalidad del 5%. La cirugía de colon y recto es una intervención quirúrgica de alta complejidad que requiere una evaluación minuciosa de cada paciente para determinar factores que determinen una mayor morbimortalidad, que podrían corregirse o controlarse, para de este modo lograr obtener una adecuada evolución postquirúrgica. Metodología: se realizó un estudio retrospectivo analítico con una muestra de 219 participantes sometidos a cirugía de colon y recto. Se evaluaron variables dependientes del paciente como la edad, sexo, comorbilidades, IMC, puntuación ASA, albumina y recuento linfocitario, además factores dependientes de la cirugía como tipo de cirugía, tiempo de cirugía, nivel de anastomosis y patología. Resultados La morbilidad encontrada en la serie fue de 23,3% y la mortalidad de 8,7%. Las complicaciones más frecuentemente encontradas fueron fuga de anastomosis en 7%, íleo metabólico 4,1%, entre otros. Tras el análisis estadístico univariado de los posibles factores de riesgo se determinó que la edad mayor de 60 años, albumina <3,5 g/dl, las transfusiones sanguíneas en el perioperatorio, cirugía de emergencia y presencia de comorbilidad resultaron significativas. Cuando se realizó el análisis multivariado solamente la albumina <3,5 g/dl y las transfusiones en el perioperatorio resultaron factores independientes. Conclusiones: La albumina <3,5 g/dl y las transfusiones sanguíneas son los factores que más influyen en el desarrollo de complicaciones en el posquirúrgico de cirugía de colon y recto.